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Psoriasis

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					  Objectives

  Chapter 51
P1437 (# 1,2,3 – physiology and patho)
      # 4, 5, 6, 7

Chapter 52 # 1, 2, 5, 6
Psoriasis
Noninfectious
Chronic
Inflammatory
Genetic makeup and environmental stimuli
May be immune system mediated
Emotional stress and anxiety aggravate
Triggers: trauma, infections, seasons,
hormones
History
Questions, pg. 1443- Box
Allergies (skin, food, cosmetics)?
Family history?
Onset, symptoms, triggers?
Pain, itching, rashes, other discomfort?
Joint discomfort?
Assessment
How pt is coping?
Impact of the disease on the patient, family
Coping strategies
misconceptions
Manifestations
Red, raised patches of skin
Scales
Bleeding points
Sites: extensor surfaces, lower back,
genitalia, scalp
Bilateral symmetry
Nails involved
  Patient problems (ns diagnosis)
  Knowledge deficit
  Impaired skin integrity
  Body image disturbance
Potential complications;
  infection
  psoriatic arthritis
  Increasing skin integrity
Avoid scratching
Avoid friction
Prevent dry skin
Water warm, not hot
Emollients
Sunscreen
Pain and itching
Humidity
Cool environment
Mild, fragrance free detergents for laundry
Avoid exposure to detergents,
Treat xerosis
Apply skin lotion immediately after bathing
Therapeutic baths
  Self-acceptance
   Physical appearance – culturally
   Emotional suffering
   Body image, a complex psychological concept
Strategies:
  informed patients less anxious
  give outlet
   promote grooming.
may benefit from counselling
Medical mgmt
Goal= slow rapid turnover of epidermis
Promote resolution of the psoriatic lesions
Control cycles of disease
Gentle removal of scales
   topical pharmacology
   intralesional therapy
   systemic therapy
   photochemotherapy
Topical agents
Tar preparations
Anthralin
Corticosteroids
Vitamin D preparation (calcipotriene)
Retinoid compounds
Corticosteroids. (p. 1065)
More effective on moist skin
More absorptive in some areas
Side effects
Malignant melanoma
Assessment: Pruritis? Tenderness? Pain
? Changes in pre-existing moles
?development of new, pigmented lesions
More assessment for those at risk

				
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posted:1/20/2012
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